Emergency Rent/Eviction Prevention Loan Application

Emergency Rent/Eviction Prevention Loan Application

JEWISH FREE LOAN — 12701 N Scottsdale Rd. Suite 206, Scottsdale, AZ 85254
Thank you for your interest in Jewish Free Loan. JFL’s interest-free loan program is available to residents of Arizona. You must be at least 18-years-of-age and a member of the Jewish community to apply.

Please complete the secure application form below and a member of the JFL staff will be in touch as soon as possible regarding your application and next steps.
Are you Jewish?*

YesNo
How did you hear about the Jewish Free Loan?*
Have you or your spouse ever applied for a loan from JFL?*

YesNo
When?*
Date
Have you or your spouse ever received a loan from JFL?*

YesNo
When?*
Date
Have you or your spouse ever co-signed for a loan from JFL?*

YesNo
For whom?*
Name
Lease Information
Please upload the first page of your lease.*

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Please upload any information you have regarding your leasing agency's policy on partial payments and third party payments. This can be found in your lease.

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Do you have an eviction notice?*

YesNo
Please attach your eviction notice here *

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If you have late fees attached to your rent, please upload the most current bill or notice showing said fees.

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Have you applied for rental assistance from any other source?*

YesNo
What is the status of your rental assistance request?*
Have you contacted Jewish Family & Children Services?*

YesNo
What is the status of your Jewish Family & Children Services application?*
Applicant Information
Amount Requested*
Reason for loan request (brief description)*
Legal Name*

First NameLast Name
Preferred Name*
Maiden name or AKA
Pronouns*

She / HerHe / HimThey / ThemPrefer Not to AnswerOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
What is your Primary Email Address?*
All future documents and communication will be sent to the email provided on this application.
Social Security Number*
Driver's License Number*
Date of Birth*

MonthDayYear
Date
City and State of Birth*
City, State
U.S. Citizen*

YesNo
In Arizona since:*
Year
If foreign born, emigrated from:*
Country
In U.S. since:*
Year
Marital Status:*

SingleMarriedDivorcedSeparatedWidow/WidowerDomestic Partner
Do you rent or own your place of residence?*

RentOwn
Monthly Rent/Mortgage*
How long have you lived at this address?*
Employment Information
Applicant's Occupation (if retired, previous occupation)*
Name of Employer*
Yearly Gross Income*
Employed since:*
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number

Area CodePhone Number
Spouse and Dependent Information
Spouse's Name*

First NameLast Name
Spouse's Maiden Name
Are they Jewish?*

YesNo
Spouse's Date of Birth*

MonthDayYear
Date
Spouse's Cell Phone*

Area CodePhone Number
Spouse's Work Phone

Area CodePhone Number
Spouse's Primary Email*
All future documents and communication will be sent to the email provided on this application.
Spouse's Social Security Number*
Spouse's Driver's License Number*
Spouse's Occupation*
If retired, previous occupation
Spouse employed since:*
Spouse's Yearly Gross Income*
Name of Spouse's Employer*
Number of Dependents*
Please provide the names and ages of any dependents. *
Additional Contact

Contact may not be spouse
Name of nearest close relative or friend*

First NameLast Name
Relationship*
Relative's Phone Number*

Area CodePhone Number
Relative's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Financial Information

Please complete information for your bank(s).*

	Name of Bank	State	Type of Account
1
2
3

Please list your average monthly income & expenses. *

	Average Total Per Month
Income
Expenses

Please summarize your income and expenses.*

	Source of Income	Monthly	Yearly	Source of Expenses	Monthly	Yearly
1
2
3
4
5
6

Other Sources of Income*

Please list your assets.*

	Assets (savings, securities, car, property equity, etc)	Amount
1
2
3

Is there any additional information that was not addressed through this application that you would like to include?*
Type N/A if none
Certification of Completeness and Accuracy, and Approval to Obtain Additional Information
- I authorize Jewish Free Loan to investigate my credit and personal history.
- I authorize agencies and persons contacted by Jewish Free Loan in connection with this application (including credit reporting agencies, banks, and social service organizations) to provide information about my credit and personal history to Jewish Free Loan.
- I certify that the information contained in this loan application is complete and accurate.
Applicant's Signature*

Clear
Please draw a full signature in the box above. If you are using a mouse: click inside the box, continue holding your mouse button down and drag your cursor to draw. If you are on a tablet: hold your finger inside the box and drag your finger to draw.
Date*

MonthDayYear
Date
Spouse's Signature*

Clear
Please draw a full signature in the box above. If you are using a mouse: click inside the box, continue holding your mouse button down and drag your cursor to draw. If you are on a tablet: hold your finger inside the box and drag your finger to draw.
Date*

MonthDayYear
Date
Borrower's Acknowledgement of Terms and Conditions

I understand and agree that the following terms and conditions will apply to my loan:
- There will be no interest charged.
- The cost of obtaining a credit report will be deducted from the proceeds of the loan.
- I will repay my loan according to the amounts and schedule stated in the promissory note that I sign.
- If I fail to make payments as agreed, Jewish Free Loan will start collection proceedings against me and my guarantors (each of whom is individually responsible for the full amount of the outstanding balance).
- I will immediately notify Jewish Free Loan about any changes in my address or in my ability to make my payments as agreed.
- I am signing this document individually.
- No Power of Attorney will be accepted.
Applicant's Signature*

Clear
Please draw a full signature in the box above. If you are using a mouse: click inside the box, continue holding your mouse button down and drag your cursor to draw. If you are on a tablet: hold your finger inside the box and drag your finger to draw.
Date*

MonthDayYear
Date
Please upload an image of your Photo ID (drivers license, passport or state ID)*

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Application can be submitted without a photo ID. However, your application will not be processed until a copy of your photo ID is received by the JFL office. Cancelof
Spouse's Signature*

Clear
Please draw a full signature in the box above. If you are using a mouse: click inside the box, continue holding your mouse button down and drag your cursor to draw. If you are on a tablet: hold your finger inside the box and drag your finger to draw.
Date*

MonthDayYear
Date
Please upload an image of your Photo ID (drivers license, passport or state ID)*

Browse Files

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Should be Empty:

Emergency Rent/Eviction Prevention Loan Application

Lease Information

Applicant Information

Employment Information

Spouse and Dependent Information

Additional Contact

Financial Information